Vacuum cannula apparatus

ABSTRACT

A vacuum curet for use with uterine aspirator apparatus. The curet has a cannula barrel with a suction port at one end, and a manifold or handle at the other. A capillary runs along the inner length of the cannula barrel terminating at the cannula tip at one end and at the manifold at the other. The entire length of the capillary is pressure-tight. The design permits introduction of appropriate fluid into the uterus at any time during the operative procedure. Introduction of the fluid may be accomplished in different ways. One way is to apply manual pressure on a squeeze tube connected either directly (or indirectly through tubing) to the curet manifold. Alternatively, a standard syringe is used in place of the squeeze tube.

United States Patent 1191 Bridgman VACUUM CANNULA APPARATUS [76]Inventor: Henry Bridgman, P.O. Box 71,

Morristown, NJ. 07961 [22] Filed: June 8, 1971 [21] Appl. No.: 151,097

Related US. Application Data [63] Continuation-impart of Ser. No.63,480, Aug. 13,

1970, Pat. No. 3,713,444.

52] UIs. cl. 128/276, 128/304 1.5 .1. 1.9991111: -11 ----:1,.A1.m.1!90[58] Field ofSearch ..l28/276278,304

15 6] Rie'rii'ces'ciieki UNITED STATES PATENTS 2,230,218 2/1941 Asche.;i.- 128/276 3,109,426 11/1963 Noonan et a1. 128/276 3,429,313 2/1969Romanelli 128/276 3.542,031 11/1970 Taylor 128/276 x 1 51, Apr. 16, 1974Primary Examiner-Charles F. Rosenbaum Attorney, Agent, or Firm-RolandPlottel [5 7] ABSTRACT A vacuum curet for use with uterine aspiratorapparatus. The curet has a cannula barrel with a suction port at oneend, and a manifold or handle at the other. A capillary runs along theinner length of the cannula barrel terminating at the cannula tip at oneend and at the manifold at the other. The entire length of the capillaryis pressure-tight. The design permits introduction of appropriate fluidinto the uterus at any time during the operative procedure. Introductionof the fluid may be accomplished in different ways. One way is to applymanual pressure on a squeeze tube connected either directly (orindirectly through tubing) to the curet manifold. Alternatively, astandard syringe is used in place of the squeeze tube. I 1 Y 10 Claims,3 Drawing Figures f'ATENTEU HR 18 I974 INVENTOR.

HENRY BFUDGMAN m y W ATTORNEYS VACUUM CANNULA APPARATUS This applicationis a continuation-in-part of my copending application entitledCollection Bottle,Ser. No. 63,480, filed on Aug. 13, I970 and now U.S.Pat. No. 3,7l3,444.

The invention relates generally to medical equipment and particularly tovacuum cannula apparatus used in uterine aspiration.

Within the past years, a technique called uterine aspiration, or vacuumcurettage, has been developed for performing abortions during the earlymonths of pregnancy. The earliest reference to this technique appearedin an article by Y. T. Wu and H. C. Wu, entitled Suction in ArtificialAbortion 300 Cases" in the Chinese Journal of Obstetrics and Gynecology,Vol. 6, 1958, beginning at page 447. A recent survey of the subjectappeared in an article by D. Kerslake and D. Casey entitled,AbortionInduced by Means of Uterine Aspirator" in Obstetrics and Gynecology,Vol. 30, July, 1967, pages 34 -45. Very briefly, the technique is toaspirate the conceptus from the uterus using a tube which has a flexibleconnection to a source of suction. A typical apparatus includes asuction curet having an oval mouth at its end, or on-one side, and anair hole at the other end to control the suction.' A rubber pressuretubing connects the curet to a transparent, e.g., glass, container whichin turn is connected to a suction pump. Aspriation of the uterinecontents usually takes less than 2 minutes and the debris can readily beseen as it appears in the glass container.

The method employed may be very briefly reviewed. The perineum, vagina,and cervix are disinfected. The cervix is then drawn forward with avulsella. The direction of the cervical canal and the depth of theuterine cavity are determined with a uterine sound. It is a commonpractice to dilate the cervix to allow easy insertion of the suctioncuret. However, dilation may be unnecessary in certain cases, and whennot needed, an anesthesia generally is not used. When dilation isrequired, a local or general anesthesia is administered. The suctioncuret of appropriate diameter and design is inserted carefully into thecervix. The suction is then started. In a few seconds the suctionreaches the working level which typically is at a mean level of 18inches of mercury (relative). The suction curet is moved gently up anddown over all aspects of the uterine cavity. The debris from theconceptus passes visibly into the glass container, either whole orpiecemeal. The degree 'of suction can be controlled with some aspiratorsby putting a thumb over an airhole in the handle of the curet as well asby using some devices on the pump. During the aspiration process, theuterus reacts by contracting and decreasing volume. Aspiration usuallytakes less than 2 minutes. It is though to be complete when the uterinewall feels smooth and no further debris emerge.

A typical apparatus used for uterine aspiration consists of a curetconnected by a hose to collection bottle which in turn is connected by asecond hose to a vacuum pump. An improved apparatus is shown anddescribed in my copending U.S. Pat. application Ser. No. 63.480 havebeen described. The curets are usually made from metal or from convertedstrong urethral catheters. The advantage of metal is that for a giveninternal diameter, the external diameter can-be less because of thestrength of the material. However, transparent curets of either glass orplastic, e.g., plexiglas are popular because cleanliness is obvious anddebris can be seen passing through during operation. Each aspiratorapparatus is outfilled with several suction curets of different sizes,and sometimes, design. Curets have been used with oval openings both onthe side and on the end to facilitate clearing the cornea. A fouropening at the working end curet has been described. A double tube curetin which sterilized water (30-50ml/min)irrigates the uterus from thecavity between the tubes while the debris passes down the inner tube,has also been described. The average curet is 25 cm long with externaldiameters ranging from 3.5 mm to 15 mm with a mode of about 8 mm. Thelarger diameter'curets are used for later pregenancies. The above citedD. Kerslake and D. Casey article reviews various types of curets.

During the normal progress of a uterine aspiration operation, less andless fetal material remains in the uterus, and the procedure becomesmore and more static. Introduction of medicinal fluid during theprocedure either constantly or intermittently, keeps the processdynamic, thus assisting remnant removal of the gentle flushing actionthus established. As the operation progresses, the uterus contracts verytightly and it often becomes necessary to introduce the lubricatingmedicinal fluid at the later portion of the operation. The need for themedicinal fluid and lubricant becomes especially important if all thefetal material is not removed on the first attempt. It is desirable thatthe surgeon have complete control over the introduction of the medicinalfluid. As the operation progresses, and becomes more static, he may wishto introduce and rapidly increase and decrease the amount of surgicalfluid. In the present invention the surgeon himself regulates the amountof fluid introduced, and may feel the amount of fluid introduced.

It is desirable that the apparatus for introducing the medicinal fluidbe uncomplicated, and not require large amount of plumbing and hoses inthe operating room, and if possible, not require a nurse or otheroperating room attendant for its proper functioning.

A further requirement of the equipment used for introducing medicinalfluid during a vacuum currettage is that it be sterile, because thefluid is introduced into the patient. Reservoir sources, whiletraditionally sterile, may become contaminated when they are introducedwith pumps and piping or plumbing necessary for introducing the fluid.

' It will be appreciated that because of the static nature of the uterusduring the latter stages of the procedure, when the fluid is mostneeded, the fluid must be intro duced under pressure, and this requiresa pumping mechanism in'the fluid reservoir source. This pressure sourcealso must be both controlled and must not introduce any source 'ofcontamination.

These and other problems are solved in the'present invention, which inone embodiment employs a surgical fluid reservoir in a plastic squeezetube, which is mounted adjacent to the handle of the curet. A capillarytube extends from the sqeeze tube reservoir along the inside ofthe curetto a capillary tip opening near the end of the cannula adjacent to thesuction port. The surgeon, in the course of the operation, whenadditional lubrication is needed,'or at the routine end of theprocedure, merely with the same hand holding the curet, squeezes thetube reservoir thereby applying pressure to the surgical fluid andforcing it to flow through the capillary tube on the inside of thecannula, and out of the cannula end at the capillary tube tip. Thesurgeon may introduce more or less fluid by squeezing the tube and thusadjusts the flow of fluid in the course of the'operation. With thisarrangement, the surgeon has complete control over the introduction ofthe surgical fluid. Thecannula is of course, sterile prior to theoperation, having been autoclaved, and the fluid source in the squeezetube may be prepared under sterile conditions. The attachment of thesqueeze tube to the can- 'nula may be done with a sterile coupling, andtypically a Luer lock connection may be used. The mating half on thesqueeze would be sterile, and covered with a cap or other plastic memberto insure its not being contaminated. Thus, the sterile condition of themedicinal fluid is insured, and the chance of contamination isminimized. it will be appreciated that in this present arrangement, themedicinal fluid is introduced by the surgeon himself, and it is notnecessary to have an operat-' ing room attendant regulate theintroduction of a medicinal fluid through an external pump or otherpressure-introducing means. Furthermore, it is not necessary to havepumps or complicated equipment in the operating room for theintroduction of the medicinal fluid, and the hoses and interconnectionsbetween such pumps and the curet are also avoided.

In an alternative embodiment of the invention, a standard syringe ismounted on the curet adjacent the handle. At the end of the operation,as is sometimes routinely done, between five and twenty cc of distilledwater, or other medicinal fluid having an antiseptic and/or analgesicproperties, are routinely introduced. At the completion of theoperation, the surgeon would pause for a moment, depress the plunger onthe syringe to force the fluid into the uterus, and then continue theoperation to remove the injected fluid. Here, again, the fluid reservoirsource is mounted on the curet and may be discharged by the surgeonhimself without the mandatory assistance ofa nurse and withoutrequiringadditional pumping of liquid handling apparatus in the operating room.

According to another aspect of the invention the cannula is of a noveldesign having a very small diameter capillary tube extending down theinside wall of the cannula barrel. The capillary tip is locatedproximate to the port but further towards the end of the cannula andcloser to the opposite side of the cannula.

A further application of the cannula of this invention is in the use ofabortions performed during the second trimester. Vacuum is considered tobe less and less effective after the 12 week of pregnancy. Abortions bysaline injection seems safer and more effective after this period.Saline injection is accomplished by withdrawing an appropriate amount ofamniotic fluid surrounding the fetus and replacing it with an equalamount of saline solution, which induces abortion by natural means. Thebasic cannula, connected to a suitable saline source may be used forthis technique. The cannala barrel under vacuum is used to withdraw theamniotic fluid and then after the vacuum has been shut off, the salinesolution is introduced into the uterus through the capillary.

The above and other objects, features and advantages of this inventionwill be apparent in the following detailed description of illustrativeembodiments thereof which are to be read in conjunction with theaccompanying drawings, wherein:

FIG. 1 is a perspective view of a vacuum curettage apparatus having thevacuum cannula of this invention.

FIG. 2 is a side view of vacuum cannula apparatus of this invention.

FIG. 3 is an end view of a portion of the vacuum cannula apparatus ofFIG. 2.

Referring to FIG. 1, there is shown a perspective view of a vacuumcurettage apparatus, in which there is shown a curet generally indicatedat 10 connected by a hose 12 to a collection bottle 14, which in turn isconnected by a. second hose 16 to a vacuum pump 18. The collectionbottle is of an improved kind, shown and described in detail in mycopending US. Pat. application Ser. No. 63,480 filed on Aug. I3, 1970.For a further detaied explanation of such collection bottles, referenceis made to said application. A standard 50 cc syringe 20 is shownattached to the curet 10. The syringe is shown attached to'the handle 22of the curet and makes ,a communicating path with a capillary tubeextending down the barrel of the curet to its tip. An additional curet30 is shown adjacent to the curet 10. It is similar to curet 10 but ofslightly different dimensions. It is customary to employ differentsize'currets depending upon the needs of the operation. It will be notedthat the curet 30, just beyond the handle,' has two connectors: oneconnector 32 is to be made with the hose 12, the second connector 34 isto be made to the standard syringe.

Referring now to the drawings of FIG. 2 and 3, there is shown in FIG. 2a side view of an alternative embodiment of the curet of the presentinvention, and in FIG. 3, an end view of the tip of the curet shown-inFIG. 2 and taken along lines 3-3. The curet includes a cannula barrel 40having a suction port 42 near one end. A capillary 44 extends along theinside length of the cannula barrel. The capillary terminates at itsouter end in a capillary tip opening 46, which extends through the wallof the cannula barrel. This is shown in both FIGS. 2 and 3. Thecapillary tip opening is near the suction port, and as shown in thefigure, is preferably further towards the end of the cannula than thesuction port, and located on the side away from the port. At the otherend of the cannula barrel'is'a manifold 48. The inside of the cannulabarrel extends through the manifold to a tapered fitting 50. A handle52, hollow along its length, fits onto the fitting 50. The other end ofthe handle 52 is provided with a coupling 54 suitable 'forinterconnection with a hose which leads to a collection bottle. Anoptional vacuum control hole 56 is shown in the handle communicatingwith the hollow interior. The surgeon may regulate the pressure in theoperating area by placing his thumb partially or wholly over this hole56. In this Figure, the interchangeable handle is shown as part of thepath leading from the suction port through the cannula barrel to thevacuum collection system. It should be appreciate that fixed handles maybe employed, such as those shown in FIG. 1, or curets with handles thatare not in the suction flow path may also be employed.

Referring again to the manifold 44, it will be seen that there is asecond port 58 through the manifold connected to the capillary 44 andterminating in a Luer lock connection 60. A squeeze tube fluid reservoir62 is shown having a mating Luer lock connection attached to themanifold connection 60.

The medicinal fluid is prepared and stored in the squeeze tube fluidreservoir 62. The fluid is sterile and the Luer lock connection 64 isalso sterile and initially covered with a protective material. Thecannula barrel and manifold are also sterile. When the operation is tobe performed, the protective material (not shown) is removed from theLuer lock connection 64 and the squeeze tube fluid reservoir is attachedto the manifold by the connectors 60, 64. The surgeon squeezes the tubereservoir 62 slightly, to force the fluid through the port 58 andcapillary 88 until a small amount of fluid emerges at the capillary tipopening 46. This is to make sure there is no air in the capillary tubeand to insure that no air is introduced into the uterus during theoperation. The vacuum curettage than proceeds in the normal manner, andat the appropriate time, the surgeon can move his fingers from thehandle 52 and squeeze the fluid from the reservoir 62. The fluid emergesat the capillary tip opening 46, and lubricates the tip of the cannulabarrel and the adjacent portions. The quantity of medicinal fluid andits rate of flow is under the complete control of the surgeon.

The reservoir has been shown attached to the curet by a standard Luerlock connection 60, 64. It should be appreciated that any convenient orconventional locking means may be employed.

A curet apparatus has been constructed in accordance with the teachingof this invention and the following dimensions for that curet are setforth below. it should be understood however, that these dimensions arefor purposes of dimensions only and variations may be made therefromwithout departingfrom the spirit or scope of the invention.

cannula barrel length: 7 Ainches cannula barrel outside diameter: 5/16inches cannula barrel inside diameter: 0.2626 inches capillary outsidediameter: 0.0778 inches capillary inside diameter: 0.0625 inchesAlthough illustrative embodiments of this invention have been describedin detail herein with reference to the accompanying drawings, it is tobe understood that the invention is not limited to those preciseembodiments, and that various changes and modifications may be effectedtherein by one skilled in the art without departing from the scope orspirit of the invention.

What I claim is:

l. A vacuum cannula apparatus comprising a cannula barrel having acuretting port at one end; capillary extending along the length of thebarrel and terminating at a capillary-tip opening proximate to saidport; a manifold at the other end of said barrel and including firstmeans for connecting said capillary to a fluid source, and second meansfor connecting said barrel interiof to a vacuum. source; handle meansfor manipulating the cannula apparatus; and a fluid source reservoirlocated adjacent to said handle means, and having connecting means tomate with said first connecting means on said manifold; said reservoirbeing self contained, and sealed but for said connection with said firstconnecting means, and of a hand squeeze type wherein the pressure andquantity of fluid expelled from said reservoir is regulated by manualpressure on said reservoir; whereby during an operation a surgeonmanipulating said cannula with one hand on said handle means may also,squeeze said squeeze type fluid reservoir to regulate the fluid flow atthe capillary tip.

2. An apparatus according to claim 1 wherein said fluid source reservoiris a syringe.

3. An apparatus according to claim 1, wherein said fluid sourcereservoir is a semi-rigid squeeze-tube.

4. An apparatus according to claim 3 wherein said squeeze-tube reservoirfits directly onto and is totally supported by said first connectionmeans.

5. An apparatus according to claim 1, wherein said second connectingmeans includes a mechanically rigidly supportive connection to saidhandle means said mechanically rigidly supportive connection being suchas to position said handle and said fluid source reservoir adjacent toone another, whereby a surgeon using the apparatus may grasp the fluidsource and the apparatus with the same hand.

6. An apparatus according to claim 1 wherein said capillary-tip openingis located further toward the end of said cannula barrel than said portand on the opposite side of said cannula barrel from said port.

7. A vacuum curet apparatus comprising a cannula barrel having acuretting port at one end; a capillary extending along the length of thebarrel and terminating at a capillary-tip opening located further towardsaid one end of said cannula barrel than said port and on the oppositeside of said cannula barrel from said port; and a manifold at the otherend of said barrel and including first means for connecting saidcapillary to a fluid source, and second means for connecting said barrelinterior to a vacuum source.

8. A vacuum cannula apparatus comprising a cannula barrel having a portat one end; a capillary extending along the length of the barrel andterminating at a capillary-tip opening proximate to said port; amanifold at the other end of said barrel and including first means forconnecting said capillary to a fluid source, and second means-forconnecting said barrel interior to a vacuum source; handle means formanipulating the apparatus; and a fluid source reservoir connectible tosaid first connecting means on said manifold; said reservoir being selfcontained, and sealed but for said connection with said first connectingmeans; and of a hand squeeze type wherein the pressure and quantity offluid expelled from said reservoir is regulated by manual pressure onsaid reservoir; whereby during an operation a surgeon manipulating saidcannula with one hand on said handle means may also squeeze said squeezetype fluid reservoir to regulate the fluid flow at the capillary tip.

9. A vacuum cannula apparatus comprising a cannula barrel having a portat one end; a capillary extending along the inner length of the barreland terminating at a capillary-tip opening proximate to said port; and amanifold at the other end of said barrel and including first means forconnecting said capillary to a fluid source, second means for connectingsaid barrel interior to an aspirator source; handle means at said firstand second means for manipulation of said apparatus; a semi-rigidsqueeze-tube fluid source reservoir connected to said first connectionmeans and located adjacent to said handle, whereby during an operation asurgeon manipulating said cannula with one hand on said handle may also,with the same hand, squeeze said squeeze-tube fluid reservoir toregulate the fluid flow at the capillary tip; said squeeze-tubereservoir fits directly onto and'is totally supported by said firstconnection means; and said squeeze tube reservoir and said firstconnecting means, include and are connected together by a Luer lock typefitting.

10. A vacuum cannula apparatus comprising a cannula barrel having a portat one end; a capillary extending along the inner length of the barreland terminating at a capillary-tip opening proximate to said port; and amanifold at the other end of said barrel and including first means forconnecting said capillary to a fluid source; second means for connectingsaid barrel interior to an aspirator source; said apparatus includes ahandle for its manipulation; a semi-rigid squeeze-tube fluid sourcereservoir connected to said first connection means and located adjacentto said handle; whereby during an operation a surgeon manipulating saidcannula with one hand on said handle may also, with the same hand,squeeze said squeeze-tube fluid reservoir to regulate the fluid flow atthe capillary tip; said second connecting means includes a rigid taperedfitting; said handle having an air passage-theret'hrough with one endrigidly mating with said tapered fitting, and the other end having meansfor making connection to the aspirator source.

1. A vacuum cannula apparatus comprising a cannula barrel having acuretting port at one end; capillary extending along the length of thebarrel and terminating at a capillary-tip opening proximate to saidport; a manifold at the other end of said barrel and including firstmeans for connecting said capillary to a fluid source, and second meansfor connecting said barrel interiof to a vacuum source; handle means formanipulating the cannula apparatus; and a fluid source reservoir locatedadjacent to said handle means, and having connecting means to mate withsaid first connecting means on said manifold; said reservoir being selfcontained, and sealed but for said connection with said first connectingmeans, and of a hand squeeze type wherein the pressure and quantity offluid expelled from said reservoir is regulated by manual pressure onsaid reservoir; whereby during an operation a surgeon manipulating saidcannula with one hand on said handle means may also, squeeze saidsqueeze type fluid reservoir to regulate the fluid flow at the capillarytip.
 2. An apparatus according to claim 1 wherein said fluid sourcereservoir is a syringe.
 3. An apparatus according to claim 1, whereinsaid fluid source reservoir is a semi-rigid squeeze-tube.
 4. Anapparatus according to claim 3 wherein said squeeze-tube reservoir fitsdirectly onto and is totally supported by said first connection means.5. An apparatus according to claim 1, wherein said second connectingmeans includes a mechanically rigidly supportive connection to saidhandle means said mechanically rigidly supportive connection being suchas to position said handle and said fluid source reservoir adjacent toone another, whereby a surgeon using the apparatus may grasp the fluidsource and the apparatus with the same hand.
 6. An apparatus accordingto claim 1 wherein said capillary-tip opening is located further towardthe end of said cannula barrel than said port and on the opposite sideof said cannula barrel from said port.
 7. A vacuum curet apparatuscomprising a cannula barrel having a curetting port at one end; acapillary extending along the length of the barrel and terminating at acapillary-tip opening located furtHer toward said one end of saidcannula barrel than said port and on the opposite side of said cannulabarrel from said port; and a manifold at the other end of said barreland including first means for connecting said capillary to a fluidsource, and second means for connecting said barrel interior to a vacuumsource.
 8. A vacuum cannula apparatus comprising a cannula barrel havinga port at one end; a capillary extending along the length of the barreland terminating at a capillary-tip opening proximate to said port; amanifold at the other end of said barrel and including first means forconnecting said capillary to a fluid source, and second means forconnecting said barrel interior to a vacuum source; handle means formanipulating the apparatus; and a fluid source reservoir connectible tosaid first connecting means on said manifold; said reservoir being selfcontained, and sealed but for said connection with said first connectingmeans; and of a hand squeeze type wherein the pressure and quantity offluid expelled from said reservoir is regulated by manual pressure onsaid reservoir; whereby during an operation a surgeon manipulating saidcannula with one hand on said handle means may also squeeze said squeezetype fluid reservoir to regulate the fluid flow at the capillary tip. 9.A vacuum cannula apparatus comprising a cannula barrel having a port atone end; a capillary extending along the inner length of the barrel andterminating at a capillary-tip opening proximate to said port; and amanifold at the other end of said barrel and including first means forconnecting said capillary to a fluid source, second means for connectingsaid barrel interior to an aspirator source; handle means at said firstand second means for manipulation of said apparatus; a semi-rigidsqueeze-tube fluid source reservoir connected to said first connectionmeans and located adjacent to said handle, whereby during an operation asurgeon manipulating said cannula with one hand on said handle may also,with the same hand, squeeze said squeeze-tube fluid reservoir toregulate the fluid flow at the capillary tip; said squeeze-tubereservoir fits directly onto and is totally supported by said firstconnection means; and said squeeze tube reservoir and said firstconnecting means, include and are connected together by a Luer lock typefitting.
 10. A vacuum cannula apparatus comprising a cannula barrelhaving a port at one end; a capillary extending along the inner lengthof the barrel and terminating at a capillary-tip opening proximate tosaid port; and a manifold at the other end of said barrel and includingfirst means for connecting said capillary to a fluid source; secondmeans for connecting said barrel interior to an aspirator source; saidapparatus includes a handle for its manipulation; a semi-rigidsqueeze-tube fluid source reservoir connected to said first connectionmeans and located adjacent to said handle; whereby during an operation asurgeon manipulating said cannula with one hand on said handle may also,with the same hand, squeeze said squeeze-tube fluid reservoir toregulate the fluid flow at the capillary tip; said second connectingmeans includes a rigid tapered fitting; said handle having an airpassage therethrough with one end rigidly mating with said taperedfitting, and the other end having means for making connection to theaspirator source.